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Charcot and the Idea of Hysteria in the Male: Gender, Mental Science, and Medical Diagnosis in Late Nineteenth-Century France

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Charcot and the Idea of Hysteria in the Male: Gender, Mental Science, and Medical Diagnosis in Late Nineteenth-Century France Medical History, 1990, 34: 363-411. CHARCOT AND THE IDEA OF HYSTERIA IN THE MALE: GENDER, MENTAL SCIENCE, AND MEDICAL DIAGNOSIS IN LATE NINETEENTH-CENTURY FRANCE by MARK S. MICALE * On concede qu'un jeune homme effemine puisse apres des exces, des chagrins, des emotions profondes, presenter quelques phenomenes hysteriformes; mais qu'un artisan vigoureux, solide, non enerve par la culture, un chauffeur de locomotive par exemple, nullement emotif auparavant, du moins en apparence, puisse... devenir hysterique, au meme titre qu'une femme, voila, parait-il, qui depasse l'imagination. Rien n'est mieux prouve, cependant, et c'est une idee a laquelle il faudra se faire. Charcot (1885) Hysteria is among the oldest recorded diagnostic categories of neurosis. Through a long and exotic evolution, the popular and medical understanding of the disorder has changed greatly. However, one feature of hysteria has remained constant: since classical times, hysteria has been understood as an affliction essentially of adult women and adolescent girls. If we know anything about the disorder, we are likely to know that it relates etymologically to the Greek word hystera or uterus. In Graeco-Roman medical literature, hysteria-or at least something that many latter-day commentators have interpreted as hysteria-was believed to develop when the female reproductive system was inactive or ungratified over time. In Plato's Timaeus and certain Hippocratic texts, we find graphic descriptions of the uterus as a restless animal, raging through the female body due to unnatural prolonged continence and giving rise to a bizarre series of symptoms, including a sensation of suffocation, heart palpitations, and loss of voice. In keeping with these beliefs, prescribed treatments for the malady through the years have included massage of the pelvic area, ovarian pressure, the application of scented drugs to entice the uterus back into place, and, perhaps most to the point, immediate marriage. As in so many areas of medicine, classical theory on this subject proved immensely influential, and for millennia hysteria was conceptualized, quite by definition, as a female sickness.' * Mark S. Micale, Ph.D., Dept. of History, Yale University, 320 York St., New Haven CT 06520, USA. I For intellectual histories of the disorder, see liza Veith, Hysteria: the history ofa disease, University of Chicago Press, 1965; George R. Wesley, A history of hysteria, Washington, D.C., University Press of America, 1979; and Etienne Trillat, Histoire de l'hyst&rie, Paris, Seghers, 1986. 363 Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.58, on 30 Sep 2021 at 19:48:05, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300052777 Mark S. Micale From a distance, the final quarter of the nineteenth century provides no exception to the rule. It was the belle epoque of hysteria, and Paris and Vienna, those quintessentially turn-of-the-century cities, its native environments. The image of hysteria in its famous fin-de-siecle phase has been of a phenomenon thoroughly female. This view has been powerfully inscribed in the historical imagination by a number of major documents, which in recent years have received a good deal of scholarly attention. In late nineteenth- and early twentieth-century Britain and America, several middle-class social and literary figures, such as Charlotte Perkins Gilman, Alice James, Eleanor Marx, and Virginia Woolf, recorded their experiences of nervous illness in memorable fictional and autobiographical accounts. In the late 1 870s, Charcot and his circle of students in Paris created dramatic representations of the female hysterical attack in the Iconographie photographique de la Salp&triere.2 And, in the following decade, Charcot's work was memorialized further in Andre Brouillet's enormous painting, Une le;on clinique a' la Salpetriere.3 Finally, in 1895, Freud and Breuer published their Studies on hysteria, which included the case histories of"Anna O." and four other hysterical women, the famous proto-patients of psychoanalytic theory. In the last decade or so, scholarly enquiry into the history of hysteria has increased at a tremendous rate.4 The bulk of this writing has been cast in what may loosely be characterized as either feminist or Freudian historiographical moulds. By now, both of these approaches have generated sizeable and significant bodies of work.5 However, the focus of investigation in these writings has been specialized. Feminist critics and historians have been concerned centrally with hysteria as a historical experience of women, particularly nineteenth-century middle-class women. Similarly, Freudian scholars have limited themselves to those portions of hysteria's history that contributed directly to the constitution of psychoanalytic theory. Furthermore, both historiographical traditions have tended to rest on a rather slender evidential base, drawing heavily on a handful of well-known documents. Not unexpectedly, hysteria emerges time and again as "the quintessential female malady".6 The question of the disease and the diagnosis as applied in the past to other patient populations has either been ignored or dismissed as statistically and therefore interpretively of little significance.7 2 D.-M. Bourneville and P. Regnard, Iconographiephotographique de la Salpetriere, 3 vols., Paris, Bureaux du Progres Medical, Delahaye & Lecrosnier, 1876-80. For a recent book-length study of this source, see Georges Didi-Huberman, Invention de l'hyst&rie. Charcot et l'iconographiephotographique de la Salpetriere, Paris, Macula, 1982. 3 Brouillet's canvas was recently the object of a special exhibition in Paris. See the informative catalogue, La lefon de Charcot. Voyage dans une toile, exposition organisee au Musee de l'assistance publique de Paris, 17 September-31 December 1986, Paris, Tardy Quercy, 1986. 4 For an attempt to account synthetically for the burgeoning historical literature on hysteria, consult Mark S. Micale, 'Hysteria and its historiography: a review of past and present writings', Hist. Sci., 1989, 27: 223-61, 317-51; and idem, 'Hysteria and its historiography: the future perspective', Hist. Psychiat., 1990, 1: 33-124. 5 For a review of these large literatures, refer to Micale (1989), op. cit., note 4 above, pp. 246-54, 319-31. 6 Quoted in Elaine Showalter, The female malady: women, madness, and English culture, 1830-1980, New York, Pantheon, 1986, p. 129. 7 There have been a number of important exceptions: Elisabeth KloW, Hysterie im Kindesalter: Zur Entwicklung des kindlichen Hysteriebegriffes, Freiburger Forschungen zur Medizingeschichte 9, Freiburg, 364 Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.58, on 30 Sep 2021 at 19:48:05, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300052777 Charcot and the idea of hysteria in the male In the present essay, I explore a segment of hysteria's famous history that hitherto has been ignored. If we move beyond a reading of canonical literary and scientific texts to a consideration of the full range of extant original sources, we discover that the late nineteenth century generated a large body ofwriting on hysterical disorders in men and children. Undoubtedly, the prime mover in this development was Charcot. During the 1880s, Charcot published the case histories of more than 60 male "hysterics" and treated countless others in his daily hospital practice. Between a third and a quarter of the overall number of hysterical patients he presented in his printed works were men or children. In these writings, Charcot formulated an elaborate set of medical ideas about the disease in males, including a theory of aetiology, a model of symptomatology, and a programme oftherapeutics. Throughout this period, Charcot campaigned energetically for his theory of masculine hysteria, and by the time of his death, in 1893, the idea was widely accepted within mainstream European medical communities. Many of Charcot's medical contemporaries judged his work on the topic to be among the most scientifically significant parts of his oeuvre, and the School of the Salpetriere, as it was called, was associated internationally with the theme of male hysteria. Beyond this, Charcot's writings on child and male hysteria were picked up during the last two decades of the century by scores of young doctors and medical students, who produced a large, if repetitive, literature on the subject, totalling over 20 books and dissertations and hundreds of periodical articles in the major European languages. Finally, Charcot's work on the theme of masculine hysteria was part of a broad cultural process occurring in many scientific and non-scientific areas oflate nineteenth-century European thought, whereby traditional definitions of masculinity and femininity underwent extensive reformulation. The fact that Charcot argued for the existence of hysterical illnesses in members of his own sex is often mentioned in present-day histories of psychiatry and psychoanalysis.8 However, nowhere do we have a close and complete examination of his ideas and their historical significance, based on the full range of extant original sources. Currently, I am preparing a monographic study of Charcot's work on hysteria in males and its place in late nineteenth-century medical culture. The present essay represents a kind of detailed progress report on that larger project, a preliminary offering of information and ideas. In what follows, I have concentrated overwhelmingly on Charcot's own writings and on the subject of hysteria in adult Hans Ferdinand Schulz, 1979; Elisabeth KWoe and Hildburg Kindt, 'Zur Entstehung und Entwicklung des kindlichen Hysteriebegriffes', Gesnerus, 1981, 38: 281-300; K. Codell Carter, 'Infantile hysteria and infantile sexuality in late nineteenth-century German-language medical literature', Med. Hist., 1983, 27: 186-96; and Showalter, op. cit., note 6 above, chapter 7. Also, Veith, writing 20 years ago, remained attentive throughout her narrative to the emergence of the idea of hysteria in men.
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